Provider Demographics
NPI:1215992540
Name:CONN, SHELLEY J (LAC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:J
Last Name:CONN
Suffix:
Gender:F
Credentials:LAC
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Mailing Address - Street 1:1824 E MEDICINE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4234
Mailing Address - Country:US
Mailing Address - Phone:763-546-3762
Mailing Address - Fax:
Practice Address - Street 1:5821 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1487
Practice Address - Country:US
Practice Address - Phone:952-545-2250
Practice Address - Fax:952-525-1088
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1254171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist